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PubMed1998

Use of and satisfaction with homeopathy in a patient population.

BACKGROUND: This article describes a survey of new clients entering care with nine practicing classical homeopaths in the Los Angeles metropolitan area between January 1994 and July 1995. METHODS: Participants completed a self-administered questionnaire before undergoing diagnosis by the homeopath. Follow-up interviews were conducted by phone 1 month after diagnosis and face to face 4 months after diagnosis, along with a self-administered questionnaire before the final interview. A total of 104 participants entered the study; 77 completed all data collection. RESULTS: Clients sought homeopathic care for a wide array of largely chronic conditions. Respiratory, gastrointestinal, and female reproductive problems were the most common primary complaints. Most clients were highly educated, but had limited knowledge about homeopathy before entering treatment. Approximately 80% reported earlier, unsuccessful attempts to get relief from mainstream care. Four months after treatment, general measures of health status showed improvement, and only 29% of participants reported no improvement for the primary complaint leading to treatment. Satisfaction with homeopathic treatment was high regardless of outcome. Three outcome measures of perceived change--overall health status, primary condition for which treatment was sought, and outlook on life--were predicted by different combinations of study variables. CONCLUSIONS: Homeopathy does not divert people from seeking mainstream care. The use of alternative modes of care such as homeopathy can be understood as attractive and satisfying to educated individuals with chronic problems.

Adult↗

PubMed1998

[Treatment of the nephrotoxicity of immunosuppressive drugs with insulin-like growth factor-I].

BACKGROUND: Delayed graft function is a common and severe complication after cadaveric kidney transplantation. Besides a more complicated postoperative course, DGF can worsen the overall graft survival. In particular, DGF enhances the nephrotoxicity of mainstream immunosuppressants cyclosporine and FK506. This study evaluates a new therapeutical approach to the treatment of DGF related nephrotoxicity, based on the administration of IGF-I. METHODS: Sixty inbred Lewis rats underwent a bilateral clamping of the renal pedicles (20') as standard damage. The animals were stratified in six groups, according to the postoperative treatment. Group 1 served as control and received only the standard ischemic injury. Cyclosporine and FK506 were added in groups 3 and 5. Groups 2, 4 and 6 had the same treatment of groups 1, 3, 5 respectively, plus the administration of IGF-I. Blood samples were drawn daily to evaluate creatinine and BUN for 7 days. RESULTS: The rats treated with IGF-I had significantly better values compared to the respective controls (2-way ANOVA, p < 0.05). CONCLUSIONS: In conclusion, IGF-I improves the nephrotoxicity of mainstream immunosuppressants in this model. Its use is potentially beneficial for transplantation.

Animals↗

PubMed1998

An organizational survey of physicians' attitudes about and practice of complementary and alternative medicine.

CONTEXT: A questionnaire was developed and administered by the Center for Addiction and Alternative Medicine Research, one of the research centers funded by the Office of Alternative Medicine. It was felt that information regarding mainstream medical usage and beliefs about alternative therapies might help to direct the focus of the center's research. OBJECTIVE: To examine the attitudes about and knowledge and practice of complementary and alternative medicine among physicians at a Midwestern teaching hospital. DESIGN: Two-part questionnaire. The first part requested demographic information, use of and familiarity with alternative therapies, research preferences, and general practice. The second part was designed for physicians with more experience in alternative modalities. PARTICIPANTS: 265 physicians working a minimum of 20 hours per week. Physicians were affiliated with the Hennepin Faculty Associates, which contracts its services exclusively to the Hennepin County Medical Center. RESULTS: A total of 109 responses were received, for a return rate of 40%. Most respondents predicted that the integration of alternative medicine at Hennepin County Medical Center would result in positive treatment, professional, and social outcomes. Physicians reported high rates of referrals to alternative practitioners, influenced in part by patients' demand and interest. Most (58.7%) respondents agreed that physicians should be knowledgeable about the most popular alternative therapies. CONCLUSIONS: The results suggest that the physicians of Hennepin County Medical Center are, if not supportive, at least open-minded about the integration of complementary and alternative medicine. Standards of evidence must be rigorous to convince mainstream medical doctors of the safety and efficacy of alternative therapies.

Attitude↗

PubMed2004

Children with cochlear implants: changing parent and deaf community perspectives.

OBJECTIVE: To examine changing parent and deaf community perspectives related to pediatric cochlear implantation. DESIGN: This research is based primarily on 2 nonrandom study designs. In the first study, conducted by the Gallaudet University Research Institute, Washington, DC, in the spring of 1999, a 12-page questionnaire was distributed to 1841 parents of children with cochlear implants; 439 questionnaires were returned. In the second study, we conducted 56 interviews with parents of 62 children with implants (and 1 without). SUBJECTS: Parents of children with cochlear implants; Gallaudet University faculty, staff, students, and alumni. RESULTS: While parents frequently receive conflicting information about educational and communication options for their child, they generally support signing before and after implantation. The parents of a child with an implant have a great interest in their child's spoken language development, and most would like to have had their child receive an implant earlier. Children with implants are educated in a variety of educational settings. Mainstreamed children with implants often continue to require classroom support services, and children with implants are frequently not isolated from both deaf and hearing peers. Parents have mixed experiences when getting information from persons in the deaf community. COMMENT: Opposition to pediatric cochlear implantation within the deaf community is giving way to the perception that it is one of a continuum of possibilities for parents to consider. To ensure optimal use of the cochlear implant, parents need to remain involved in their child's social and educational development.

Adolescent↗

PubMed2006

Residual language deficits in optimal outcome children with a history of autism.

This study examined whether language deficits persist even in children with optimal outcomes. We examined a group of children with prior diagnoses on the autism spectrum who had IQs in the normal range, were in age-appropriate mainstream classes, and had improved to such an extent that they were considered to be functioning at the level of their typically developing peers. Fourteen such children between the ages of five and nine were matched on age and sex with typically developing children, and were given a battery of 10 language tests to investigate their language abilities. Results indicated that while these children's grammatical capabilities are mostly indistinguishable from their peers, they are still experiencing difficulties in pragmatic and semantic language.

Asperger Syndrome↗

PubMed1993

The optimization of hearing-impaired children's speechreading.

As more hearing-impaired and deaf children are mainstreamed into regular schools and as age related hearing loss in advanced countries become more prevalent, so the need for optimal methods to teach speechreading increases. The numbers of children and adults who would benefit from improved methods of teaching speechreading must be considerable. No new methods of teaching speechreading have been developed since 1938. Speechreading is a skill that does not require complex technology, although it does augment the effectiveness of hearing aids. Increased knowledge of this skill would have great benefits in psychological, social and economic terms. Some relevant experimental psychological literature and the views of educators are discussed with the goal of contributing to the optimization of hearing-impaired children's speechreading.

Child↗

PubMedDate not supplied

Parent- and self-ratings of anxiety in children with mental retardation: agreement levels and test-retest reliability.

This study examined fears in children with and without developmental disabilities. Children assigned to classes designed as developmentally handicapped (D), integrated (or mainstreamed) (I), and regular (R) were assessed. In all, 82 children were tested and retested over a 2-week interval. Self ratings and parent ratings were obtained. Three instruments were used to assess specific fears, social anxiety, social competence, and behavior problems: the Fear Survey Schedule for Children--Revised, the Social Anxiety Scale for Children, and the Child Behavior Rating Form. Correlations between parent and child ratings were fair to good. Child-parent agreement was nonsignificantly higher for children without disabilities and for children with mild handicaps integrated into regular education programs than for children in classes designated as Developmentally Handicapped. Children's test-retest reliabilities were generally higher than those of parents. Children without disabilities showed significantly higher consistency over time than children with disabilities.

Adolescent↗

PubMedDate not supplied

School reentry and the child with a chronic illness: the role of the pediatric nurse practitioner.

Being attentive to the educational needs of chronically ill children is a relatively recent development in American education. Advances in medical sciences that have improved survival rates for some conditions and increased public acceptance of people who are different or disabled and legislation that has established education as an entitlement for all children have allowed for the entrance of many chronically ill children into mainstream education. Successful school reentry is essential if the child is to develop normally, in terms of intellect, social skills, and peer relationships. Caregivers must not lose sight of the fact that school provides opportunities for social, emotional, and cognitive development. Thus the pediatric nurse practitioner can promote the benefits gained from schooling in numerous ways and provide the child, family, and school personnel with the support and information needed for a smooth transition back into the school system.

Child↗

PubMed2006

Impact of epilepsy characteristics and behavioral problems on school placement in children.

Children with epilepsy are known to be prone to educational underachievement as a result of learning and behavioral problems. This cross-sectional study evaluated the effects of the characteristics of epilepsy and behavioral problems on school placement. One hundred eighty-five children aged between 3 and 16 years with nonoccasional epileptic seizures were included; 82 were mainstreamed in regular schools and 103 were in specialized medical and educational institutions for children with epilepsy. Gender distribution and age were comparable for the two groups. Logistic regression analysis indicated a statistically significant effect for age at onset, generalized nonidiopathic epileptic syndromes, number of antiepileptic drugs and behavioral problems, as dominant factors explaining the type of school placement. No significant effect was found for the state of seizure control. By use of a parent-rated behavior questionnaire, children in special institutions were shown to have significantly more problems in the hyperactivity/attention deficit and sociability domains. Later age at onset of epilepsy was related to more depression/anxiety.

Adolescent↗

PubMed1994

School performance at nine years of age in very premature and very low birth weight infants: perinatal risk factors and predictors at five years of age. Collaborative Project on Preterm and Small for Gestational Age (POPS) Infants in The Netherlands.

To assess the impact of both perinatal disorders and developmental problems identified at preschool age on school performance, we followed a virtually complete birth cohort of very premature (< 32 completed weeks of gestation) and very low birth weight infants until they were 9 years of age. In 84% of the survivors (n = 813), data on school performance were available for analysis. At the age of 9 years, 19% of the children were in special education. Of the children in mainstream education, 32% were in a grade below the appropriate level for age and 38% had special assistance. After correction for other perinatal items, children of low socioeconomic status and boys had significantly higher adjusted odds ratios for special education. Logistic regression with a perinatal and a 5-year time category showed that the most predictive factors for special education were developmental delay, neuromotor and speech/language function, inattention and hyperactivity score, total problem score, and reported school results at the age of 5 years. When children with disabilities were left out of the analysis, the importance of neuromotor function and total problem score disappeared. Increased risks of any school failure in nondisabled children included mild or severe developmental delay and marginal or poor school performance at the age of 5 years. Long-term follow-up with specific attention to these predictors at 5 years of age, although time-consuming, is necessary.

Birth Weight↗

PubMed1997

A model of educational resource use by children with cochlear implants.

We have tracked patterns of use of educational and rehabilitative resources as part of an initial assessment of cost-benefit ratios of cochlear implants in children. Forty-two children with cochlear implants in the Listening Center at Johns Hopkins program of aural rehabilitation have served as our study cohort to develop the measures to be assessed. An educational resource matrix stratifies school setting (residential vs special education vs non-specialized "mainstream" setting) and levels of rehabilitative support (speech and language therapy and interpreter use) to map past and current use of these services. Initial cost-benefit projections based on observed advancement toward educational independence in the educational resource matrix indicate an extremely favorable net present value of the implant (cost savings minus cost). These cost-benefit projections will need to be supplemented with measures of the impact on quality of life and future educational and vocational options to determine the overall cost-effectiveness of cochlear implants in children.

Baltimore↗

PubMedDate not supplied

Self-management within a classroom token economy for students with learning disabilities.

Students with disabilities who are served in restrictive educational settings often display inappropriate behavior that serves to preclude their integration into the mainstream. One approach to managing difficult behavior is a levels system (Smith & Farrell, 1993), which typically consists of a hierarchy of levels in which students must meet increasingly demanding standards of behavior before advancing through the hierarchy. In the present study, two middle-school students with learning disabilities participated in a classroom-wide token economy based on a levels system. The levels system, which was used in a self-contained classroom, targeted the acquisition and maintenance of academic skills and social behaviors with the goal of integrating these students into an inclusive classroom. The two participants showed little or no progress within the levels system because of a very high rate of inappropriate verbalizations. Therefore, a self-management system that involved training on the accuracy of self-recording these verbalizations was added to the levels system for these students. In addition, the investigator discussed with these students the consequences of inappropriate behavior and socially appropriate behavioral alternatives. A multiple-baseline-across-subjects experimental design revealed that the intervention resulted in a substantive reduction in inappropriate verbalizations, as well as greater progress through the levels system. Implications of these findings for the use of self-recording within a token economy, the importance of students' accuracy of self-recording, and methodological issues are discussed.

Achievement↗

PubMed2003

Behavioural and emotional characteristics in children with Sotos syndrome and learning disabilities.

In contrast to physical characteristics, the developmental and behavioural characteristics of children with Sotos syndrome are not well documented. Data from a survey of 27 children (17 males and 10 females; mean age 10 years 7 months; range 6 to 15 years) with mild and moderate learning disabilities were obtained concerning school placement, social networks, adaptive competence, and behavioural problems and compared with a control group matched for cognitive level and age. Ten children attended a mainstream school (with remedial assistance), eight were placed in a school for children with learning disabilities, nine children attended other special schools. Social contact problems and anxious behaviour were reported as the most prominent characteristics of children with Sotos syndrome. Some implications for psychological counselling and educational support are discussed.

Achievement↗

PubMed2005

Education and employment prospects in cerebral palsy.

Parents and paediatric neurologists need information on the long-term social prognosis of children with cerebral palsy (CP). No large population-based study has been performed on this topic. On 31 December 1999, to find predictors in childhood of subsequent education and employment, 819 participants with CP born between 1965 and 1978 (471 males; mean age 28y 10 mo, SD 4y, range 21 to 35y) in the Danish Cerebral Palsy Registry were compared with 4406 controls without CP born between 1965 and 1978 (2546 males; mean age 28y 10 mo, SD 4y, range 21 to 35y). Diagnostic subtypes of the 819 participants with CP were: 31% hemiplegia, 43% diplegia, 18% tetraplegia, and 8% other types. Level of motor impairment with respect to walking ability was: 62% able to walk without assistance, 21% with assistance, and 16% not able to walk (for 1% of study children walking ability was not known). Relevant information was obtained from Denmark's unique registries. Of the participants with CP, 33% vs 77% of controls, had education beyond lower secondary school (i.e. after age 15-16y), 29% were competitively employed (vs 82% of controls), 5% were studying, and 5% had specially created jobs. Excluding participants with CP with an estimated developmental quotient (DQ) of less than 50 or inability to walk at age 5 to 6 years, the odds ratios (multivariate analysis) for not being competitively employed were 1.9 for diplegia versus hemiplegia, 22.5 for DQ 50 to 85 versus DQ greater than 85, and 3.7 for those with epilepsy versus those without epilepsy. The severity of motor impairment among participants with CP able to walk had just a minor influence. Only half the participants with CP who had attended mainstream schooling were employed. In conclusion several childhood characteristics seemed to predict long-term social prognosis.

Adult↗

PubMed1999

Parental perspectives on inclusion: effects of autism and Down syndrome.

This study examined the effects of the child's diagnosis (autism vs. Down syndrome), age, and current educational placement on parental perceptions toward inclusion for their child with disabilities. Parents of children with autism and with Down syndrome completed surveys regarding their opinions on their child's current educational placement, their desire for changing the current placement, and their views on inclusive education. Results indicated that diagnosis, age, and current placement influenced parental opinion on the ideal educational placement for their child. Parents of children with Down syndrome were significantly more likely to endorse inclusion (full-time placement in general education) as the ideal educational program for their child whereas parents of children with autism were more likely to endorse mainstreaming (consistent part-time placement with general education students). Parents of younger children and parents whose children were already placed in general education programs were more positive towards inclusion than parents of older children or students currently in special education. Findings are discussed in terms of child characteristics and prevailing educational practices.

Adolescent↗

PubMed1998

Education for children with disabilities: the rationale for inclusion.

OBJECTIVE: To discuss issues in the education of children with disabilities, particularly with respect to inclusion in mainstream classes. METHODOLOGY: Review of the literature on education for children with disabilities, focusing on the inclusion versus segregation debate. RESULTS: The literature provides no support for segregation and some support for the view that segregated children are disadvantaged. What seems to be important is the way the child is educated rather than where the education takes place. In addition, there are ethical, sociological, and legal arguments in favour of an inclusive educational system. CONCLUSIONS: There are good arguments to encourage inclusive education for children with disabilities. In advising parents, doctors should focus on how rather than where the child with a disability should be educated.

Child↗

PubMed2003

[Pediatric cost-benefit analysis].

BACKGROUND: The aim of this study was to explore the cost-benefit-ratio of pediatric cochlear implantation for congenitally deaf and prelingually deafened children compared to children with hearing aids. The payers' perspective was chosen as this is the most relevant for cost discussions. The study should verify the hypothesis that educational and associated full costs increase with the age at implantation and that these can be below costs for children with hearing aids. METHODS: Children implanted at different ages (group 1: 0 - 1.9 yr., group 2: 2 - 3.9 yr., group 3: 4 - 6.9 yr.) were compared with deaf children using hearing aids (group 4). Payers were sick funds and public authorities, the first paying for medical and indirect costs, the latter paying for education. Educational settings were used as measure for benefit. All costs related to the hearing deficiency were included up to the age of 16 years (end of primary education) based on 1999 costs. RESULTS: Discounted medical and indirect costs for a pediatric cochlear implant user varied between DM 112,000 (53,300 US dollars) and DM 91,000 (43,300 US dollars) depending on the age at implantation. Costs for a hearing aid user added up to DM 36,000 (17,100 US dollars). These costs were paid by the sick funds. Costs for education varied between DM 159,000 (75,700 US dollars) for group 1 and DM 257,000 (122,400 US dollars) for group 3 compared to DM 277,000 (131,900 US dollars) for hearing aid users. These differences are mainly based on the use of mainstream schools. Total costs for sick funds and public authorities ad up to DM 271,000 (129,000 US dollars), DM 334,000 (159,000 US dollars) and DM 348,000 (165,700 US dollars), respectively, for the three age groups of implanted children compared to DM 313,000 (148,600 US dollars) for hearing aid users. CONCLUSION: This study supports the view that pediatric cochlear implantation provides positive cost-benefit ratios compared to hearing aid users depending on the age at implantation. From a societal/payer perspective implantation of prelingually deafened children is especially recommended for children under the age of 2 years. Implantation between ages 2 and 3,9 can be recommended from an educational perspective. Implantation at ages >7 years must be based on individual decisions considering psychosocial environment, speech and language status and type of communication.

Adolescent↗

PubMed1993

Attitudes of preschool children toward their peers with disabilities: a year-long investigation in integrated classrooms.

Changes in choices of preferred playmates by 3- and 4-year-old children were observed over the course of a school year. All of the children in this study participated in planned, fully mainstreamed, same-age preschool classes. Sociometric assessments were obtained from all children without disabilities in October, February, and May of the school year; peer nominations of three "best friends" were obtained at the beginning and end of the school year. The 3-year-old children showed a general decline in the ratings given to all of their peers over the course of the school year. Four-year-old children showed significant preferences for same-sex peers without disabilities as playmates. The implications of these findings for integrated programs are discussed.

Attitude↗